Preview
4217 - Continuance - Allowed 4435 - Order on Motion to Provide Medical Insurance - Allowed 4 Fe
420 - Order, Plaintiff, Defendant or Witness to Appear - Allowed 4512 - Order Arrearage Set (amount needed) - Allowed
4253 - Produce Exhibits or other Records or Documents or Person - Allowed 4867 - Order For Child Support - Allowed
4284 - Strike or Withdraw Motion or Petition - Allowed 4568 - Order Temporary Maintenance - Allowed
4312 - Finding of Delinquency - Allowed 4600 - Order Support Payments Made Direct to Petitioner
4324. - Child Support Order Above Statutory Guidelines - Allowed 4601 - Order Support Payments Made Direct to C.C.CJS.D.U, - Allowed Ne At
4325. - Child Support Order Below Statutory Guidelines - Allowed 4604 - Order Support Payments Made Direct to Respondent - Allowed 5
4386_- Order to Pay Fees - Allowed
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS 4
COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION 07
UNIFORM ORDER FOR SUPPORT
Dxhnitial Order (Modification (JEnforcement (CJurrsa
— '
Lommelia Mekay Docket No.: ] Fd LSO/§ 7
etitioner ligee bligor .
Petiioner /L>yoPtgee [_] Obl wnorc 03199693
ovs-
Calendar No.: &h
8 \ante/l WDechi ingho~ Sg tinois Department of Healtheare and Family Services is,
Respondent /{_] Obligee WLObligor or has been, granted leave to intervene.
Definitions: Obligor - An individual who owes a duty to make support payments pursuant to an Order for Support
Obligee - An individual to whom a duty of support is owed or the individual's legal representative
Payor - Any payor of income to an Obligor
Unallocated Support - A total amount for maintenance and child support and not a specific amount for either
THIS MATTER coming to be heard on Petition for (_] Rule and/or Modifi ication Y=] Support [_| Judgment
The Court Finds: .
e
The Court has jurisdiction of the parties ae j ues matter and that due notice was given by CO etinw. ance
on
- a) The net income of the Obligor is $ / 3Y3. oO perlVOnnLA :
b) The amount of arrearage/judgment for child support is $ as of (date), interest
is $ as of (date), (_] interest prior to January 1, 2000, is reserved,
maintenance or unallocated support is $ as of. (date) and/or medical support is
as of. (date).
Oo c) The amount of child support cannot be expressed exclusively as a dollar amount because all or a portion of
the Obligor's net income is uncertain as to one time of payment, or amount.
Bt d)_Retroactive child support is $ I 8 from 3 - a AG to q 1D VG
The [Obligee [_] Obligee's Attorney LY Obligor LJ Obligor's Attorney_[y- Assistant State's Attorney, being present
(2 This matter being an Interstate Case, [_] Voluntary Acknowledgement of Paternity was signed on
It is Ordered: S}-After hearing (_] By agreement of the pee Ahan sha that:
Sh4G LEAL , Obligor, is to provide:
oO MAINTENANCE (Do not complete this section if Unallocated Support is ordered.)
Payment Amount: Payment Frequency:
Current Maintenance: $ Li every week Devery other week
Arrearage Payment $ CU monthly
LD twice each month on &
Payments Begin: (date) Di other (date)
AXCHILD SUPPORT OR [] UNALLOCATED SUPPORT
Payment Amount: Payment Frequency:
Current Child Support Payment or
Unallocated Support Payment: IAS +O Clevery week LD every other week yf monthly
Arrearage/Retroactive Payment: $ 10-0 C1 twice each month on &
Other Payment: $ UD other (date)
Payments Begin: g- 13, _/ F (date)
Judgment in the amount of $ /[6SOQ-O1D _ plus interest of $ ~~ for a total due ofs/L§O *@y is
entered against the Obligor on the arrears.
SAO 2500-1 [Rev. 08/17] Page iF. ofS so aaemtLD PERCENTAGE AMOUNT OF CHILD SUPPORT (Complete this section only if finding (c) is checked above.) Oo
In addition to the specific dollar amount of support ordered above, current child support shall be paid in the amount of
% of Obligor's payable ! The Obligor is further
ordered to provide income records sufficient to determine and enforce the percentage amount of child support
within 7 days of receipt of income subject to this percentage assessment, to the [_]Obligee and [_] Clerk of the Court.
{J ADDITIONAL CONDITIONS OR FINDINGS
o Child support payment amount deviates from the amount required by statutory minimum guidelines. The amount of
support that would have been required under the guidelines is $ .
Reasons for deviation:
oO Child Support is based on the needs of the child.
The Child/ren covered by this Order is/are:
nse!) Washinton re Montirvear ot Binns PALO A
Month/Year of Birth:
Month/Year of Birth:
Month/Year of Birth:
PAYMENT ARRANGEMENTS
he (Payments must be sent to the STATE DISBURSEMENT UNIT if this box is checked.)
A Notice to Withhold Income shall be issued immediately and shall be served on the employer at the address listed in this Order.
Payments shall be made payable to the State Disbursement Unit and sent to the State Disbursement Unit at P.O. Box 5400, Carol
Stream, IL 60197-5400. Payments must include CASE NUMBER, COUNTY of the Court issuing this Order, and Obligor's name and
social security number. Any subsequent employer may be served with a Notice to Withhold Income without further order of the
Court.
In addition to and separate from amounts ordered to be paid as maintenance or child support, the Obligor shall pay a $36 per year
Separate Maintenance and Child Support Collection Fee. This sum shall be paid directly to the Office of the Clerk of the Circuit
Court, Child Support Division, Richard J. Daley Center, 50 West Washington Street, Room LLO1, Chicago, IL 60602, and not to the
State Disbursement Unit.
DELINQUENCY
If the Obligor becomes delinquent in the payment of support oer the entry of this Order for Support, the Obligor must pay, in
addition to the current support obligation, the sum of (a) $ 5S 1 OW for delinquent child support per the payment
_ frequency ordered above for child support, and (b) $ for delinquent maintenance or unallocated support
per the payment frequency ordered above for maintenance or unallocated support, until the delinquency is paid in full. (This
additional amount, the total of (a) and (b), shall not be less than 20 percent of the total of the current support amount and the amount
to be paid for payment of any arrearage stated in the Order for Support.) A support obligation, or any portion of a support obligation
which becomes due and remains unpaid for 30 days or more, shall accrue interest at the rate of 9% per annum.
pocketNo: GALS OD) EF IV-D No: C 03/94 C3
SAO 2500-1 [Rev. 08/17] Page 2 of 5TERMINATION : |
This obligation to pay child support terminates mite child [[] youngest child's 18" birthdate unless modified by written order of
the Court or unless the child is still attending high school after attaining the age of 18, then the termination date shall be the earlier of
the child's high school graduation or the date on which the child will attain the age of 19. This termination date does not apply to any
arrearage that may remain unpaid on that date.
ARREARS PAYMENT
If on the termination date (if no termination date, then on date the child attains majority or otherwise emancipates) there is an unpaid
arrearage or delinquency equal to at least one month's support obligation, the amount being paid immediately preceding termination,
including any current support payment, arrearage payment and/or any delinquency, will continue to be collected as an obligation, not
as current support, but as a periodic payment toward satisfaction of the unpaid support.
MEDICAL INSURANCE
The [_]Obligor, [[] Obligee, [| Obligor and Obligee, shall provide health insurance for the child(ren): [_] as provided in
previous order entered on ; []by enrolling them in any health insurance coverage available through the
[J Obligor's, [] Obligee's, [=] Obligor's and Obligee's, employment or [_] by securing a private health insurance policy, accepted
by the Obligor and Obligee or approved by the Court, which names the child(ren) as beneficiary. The Obligor shall provide to the
Obligee a copy of the insurance policy and the insurance card within 45 days. The employer or labor union or trade union shall
disclose information concerning dependent coverage plans whether or not a court order for medical support has been entered.
750 ILCS 5/505.2.
Oo The Obligor is liable for % of medical expenses incurred by the minor child(ren) and not covered by insurance.
Oo Upon obtaining employment which provides dependent health/hospitalization insurance at reasonable costs; or upon
Obligor's employer making dependent health/hospitalization insurance available at reasonable costs, Obligor must
immediately enroll the aforementioned child(ren) in the employer's health/lospitalization insurance plan.
Re The issue of medical insurance s reserved 7 yigharaWi Stok Prou idan - lag Pahilerbre
It is further ordered that (except when the Court finds that the physical, mental or emotional health of a party or that of a minor child,
or both, would be seriously endangered by disclosure of the party's address):
The Obligor shall give written notice to the Clerk of the Court, and ifa party is receiving child and spouse services under Article X of
the Illinois Public Aid Code, to the Illinois Department of Healthcare and Family Services, (HFS) within 7 days, of:
. any new residential, mailing address or telephone number;
. the name, address and phone number of any new employer, and;
. the policy name and identifying number(s) of health insurance coverage available.
The Obligor shall submit a written report of termination of employment and of new employment, including name and address of the
new employer, to the Clerk of the Court and the Obligee within 10 days. Obligor and Obligee shall advise each other of a change of
residence within 5 days except when the Court finds that the physical, mental or emotional health of a party or that of a minor child,
or both, would be seriously endangered by disclosure of the party's address. An Obligee receiving payments through income
withholding shall notify the Clerk of the Court and the State Disbursement Unit within 7 days, of a change in residence. The Obligor
and Obligee shall report to the Clerk of the Court any change of information included in the Child Support Data Sheet (Exhibit 1)
within 5 business days of such a change.
UNEMPLOYMENT
{ Obligor is unemployed and is ordered to'seek employment. The Obligor must report periodically to the Court with a diary listing
the name, address, telephone number and contact person of each employer with which he or she has sought employment.
Obligor is ordered to report to the Department of Employment Security for job search services or to complete an application with
the local Job Training Partnership Act provider for participation in job search, training or work programs.
[i Obligor is unemployed and is ordered to put forth a diligent effort to obtain employment and to cooperate with all instructions of
HFS. Upon finding employment, the Obligor shall notify HFS in writing at 36 South Wabash, #* Floor, Chicago, IL 60603 within 7
days. The Obligor's failure to comply with the requirements of this Order may result in the State's Attorney seeking a contempt
of court order.
Docket No.: /Gdb50] eq wpnic O31 FIG LFF
SAO 2500-1 [Rev. 08/17] Page 3 of 5(GENETIC TEST REIMBURSEMENT: Obliigor shall pay $ to HFS for a genetic, itest reimbursement.
Payments must be made in lump sum or installments by personal check or money order payable to HFS and either mailed to:
HFS, Title IV-D Accounting Unit, P.O. Box 19138, Springfield, IL 62705-9138, or conveyed as otherwise directed by the Court.
Payment must include IV-D number as shown on this Order.
This Order does not preclude HFS from collecting any arrearage established by or which may accrue under this Order for Support by
use of the offset provisions of Section 6402 (c) of the Internal Revenue Code of 1954, and 15 ILCS 405/10.05(a) as amended, Such
arrearage shall be considered as “past due” or “due and payable” within the meaning of said statutory provisions. This order does not
preclude the placing of a lien on real and personal assets or initiating a proceeding for garnishment, attachment of sequestration
pursuant to law and the Code of Civil Procedure.
This order of support supersedes any and all prior orders of support under this case number.
COTHER:
4
( This cause is continued for 6 ff Ca l/ to at
Room at
oO Richard J. Daley Center, 50 W. Washington, oO Richard J. Daley Center, 50 W. Washington,
Chicago, IL Concourse Level - Room CL24, Chicago, IL
Oo District 2 - 5600 Old Orchard Road, Skokie, IL oO District 5 - 10220 South 76" Ave., Bridgeview, IL
Oo District 3 - 2121 Euclid Ave., Rolling Meadows, IL [] District 6 - 16501 South Kedzie, Markham, IL
oO District 4 - 1500 Maybrook Drive, Maywood, IL
(1) without further notice [_] without further notice to Petitioner [_] without further notice to Respondent
FAILURE TO APPEAR MAY RESULT IN ENTRY OF A DEFAULT JUDGMENT
Docket No.: LGA LSOlPY . IV-DNo:C (3 197k $3
SAO 2500-1 [Rev. 08/17] Page 4of5(J FOR EXPEDITED CHILD SUPPORT CASES ONLY: ‘ '
I
NOTICE OF RIGHT TO REQUEST A JUDICIAL HEARING: You have a right to request a Judicial Hearing. If either party does
not agree to the recommended Order or any part thereof, this case will be transferred for an immediate Judicial Hearing.
This Order may be vacated or amended within 30 days of its entry. This Order is not valid until signed by a judge.
So recommended to the Court by the Hearing Officer this day of ’ .
Hearing Officer's Signature
Petitioner/ Obligee's Signature Respondent/ Obligor's Signature
y
Petitioner/ Obligee's Attorney's Signature Respondent/ Obligor's Attorney's Signature
FAILURE TO OBEY ANY OF THE PROVISIONS OF THIS ORDER MAY RESULT IN A
FINDING OF CONTEMPT OF COURT
tlie ha
Date
KIMBERLY M. FOXX # 17052
State's Atto of Cook County
By:
28 North Clark, Suite 30
Chicago, Illinois 60602
(G12) 345-2200
sao.csed@cookcountyil.gov
‘Asdistant State's Attorney, fone HFS)
Docket No.: JFE&LSOLPG IV-D No: C. 03/79 4L73 :
SAO 2500-1 [Rev. 08/17] Page Sof 5IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS '
DOMESTIC RELATIONS DIVISION
Hingis Department of Healthggre and Family Services ex rel., .
“Tomnmelia Mekan . poset no: LFA LSOIEF
Petitioner, |
Iv-DNo:c OD! 13,
Calendar No.: PL
ORDER OF P. ITAGE
This matter coming to be heard on a complaint to establish the parentage of, Shantel l Washingin SI _ born on
9 Jedoe .
PRESENT ARE:
(X— Petitioner on behalf of a minor child/ren Respondent “BYP Assistant State's Attorney’ [[] Public Defender
oO Petitioner's Attorney [_] Respondent's Attorney [7] Court Interpreter [_] Child/ren
-~vs-
Fhantel! Washingbn
Respondent.
Hearing is: [By Agreement [[] Default [[] Bench Trial
THE COURT FINDS AS FOLLOWS:
& Respondent, was [_] personally served xf served by substitution on 4 4 ‘S" ! 1 :
Respondent is not in the military [_] is in the military.
Respondent has appeared and waived any defects in process.
x Respondent admits parentage.
Be Respondent received a copy ope genetic test,results and was advised of his rights to trial.
The natural mother is Tommelia Makau date of birth a) and has testified
Min person [_] pursuant to affidavit that Respondent is the natural father of taal child/ren id that no other person could be the father.
Therefore, the Court further finds that the natural father is It noah ‘ f o~
The Respondent:
Name: andel 1 Washington pate of Birth 1/1 FFI.
on
Curent Address: PAL Hunees Te Fra | City, Sate, zip Sun Prairie, 0) S3S%
IT IS HEREBY ORDE!
1. That Shank wd aching ton is adjudicated the natural and biological father of said minor child/ren.
2. Retroactive support is:
Lireserved [_] continued for nearing (1 denied—-S¥} granted by separate Order [“] withdrawn.
3. Support is:
[Jreserved [_] continued for hearing-fP] granted by separate Order (F withdrawn.
4. Medical provisions [_] reserved continued for hearing []denied [] granted by separate Order Fe} withdrawn.
5. The child/ren's legal name shall be
6. Custody and Visitation
[[] Mother Father shall have custody of minor child/ren.
(_] Father Mother shall have reasonable visitation rights.
Reserve []Custody, [[]Visitation —)—
7. Continuance Date of C. l/
o This matter is continued for Hearing on as 20 at at
Oo Richard J. Daley Center, 50 W. Washington, Room Chicago, IL for the purpose of
oO Richard J. Daley Center, 50 W. Washington, Concourse Level - Rm. CL24, Chicago, IL for the purpose of
oO District 2 - 5600 Old Orchard Road, Room Skokie, IL for the purpose of
Oo District 3 - 2121 Euclid Avenue, Room » Roliing Meadows, IL for the purpose of
Oo District 4 - 1500 Maybrook Drive, Room *, Maywood, IL for the purpose of
[1 __ District 5 - 10200 South 76" Avenue, Room , Bridgeview, IL for the purpose of
oO District 6 - 16501 South Kedzie, Room Markham, IL for the purpose of
(without further notice [[] with notice to [[] Petitioner [_] Respondent [_] with affidavit of mailing
‘SAO 2500-003 I-PAD [Rev. 05/17] Page 1 of 28. « (senehc Jest Reotts gow 94 7994p Ordeal;
F eaten,
I
RESPONDENT'S FAILURE TO APPEAR MAY RESULT IN ENTRY OF A DEFAULT JUDGMENT AGAINST RESPONDENT.
NOTICE OF RIGHT TO REQUEST A JUDICIAL HEARING: You have a right to request a Judicial Hearing. If either party does not
agree to the recommended Order or any part thereof, this case will be transferred for an immediate Judicial Hearing.
THIS ORDER IS NOT VALID UNTIL SIGNED BY A JUDGE
So recommended to this Court by the Hearing Officer this
Hearing Officer's Signature
lef loofre Sigring
Petitioner's Signature
Petitioner's Attorney
KIMBERLY M. FOXX # 17052
State's Attokut¥ of Cook Count
By:
orth Clark, Suite 300
Chicago, Illinois 60602
(312) 345-2200
sao.csed@cookcountyil.gov_
Assjétant State's Attorney, (Attorney “y
28
Docket No.:
‘SAO 2500-003 I-PAD [Rev. 05/17]
dent's Signature
Respondent's Attorney
ENTERED: q / iol (Tt
weal HEN a
Judge's No.
IV-D No.: C
Page2of2
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4217 - Continuance - Allowed 4435 - Order on Motion to Provide Medical Insurance - Allowed 4 Fe 420 - Order, Plaintiff, Defendant or Witness to Appear - Allowed 4512 - Order Arrearage Set (amount needed) - Allowed 4253 - Produce Exhibits or other Records or Documents or Person - Allowed 4867 - Order For Child Support - Allowed 4284 - Strike or Withdraw Motion or Petition - Allowed 4568 - Order Temporary Maintenance - Allowed 4312 - Finding of Delinquency - Allowed 4600 - Order Support Payments Made Direct to Petitioner 4324. - Child Support Order Above Statutory Guidelines - Allowed 4601 - Order Support Payments Made Direct to C.C.CJS.D.U, - Allowed Ne At 4325. - Child Support Order Below Statutory Guidelines - Allowed 4604 - Order Support Payments Made Direct to Respondent - Allowed 5 4386_- Order to Pay Fees - Allowed IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS 4 COUNTY DEPARTMENT, DOMESTIC RELATIONS DIVISION 07 UNIFORM ORDER FOR SUPPORT Dxhnitial Order (Modification (JEnforcement (CJurrsa — ' Lommelia Mekay Docket No.: ] Fd LSO/§ 7 etitioner ligee bligor . Petiioner /L>yoPtgee [_] Obl wnorc 03199693 ovs- Calendar No.: &h 8 \ante/l WDechi ingho~ Sg tinois Department of Healtheare and Family Services is, Respondent /{_] Obligee WLObligor or has been, granted leave to intervene. Definitions: Obligor - An individual who owes a duty to make support payments pursuant to an Order for Support Obligee - An individual to whom a duty of support is owed or the individual's legal representative Payor - Any payor of income to an Obligor Unallocated Support - A total amount for maintenance and child support and not a specific amount for either THIS MATTER coming to be heard on Petition for (_] Rule and/or Modifi ication Y=] Support [_| Judgment The Court Finds: . e The Court has jurisdiction of the parties ae j ues matter and that due notice was given by CO etinw. ance on - a) The net income of the Obligor is $ / 3Y3. oO perlVOnnLA : b) The amount of arrearage/judgment for child support is $ as of (date), interest is $ as of (date), (_] interest prior to January 1, 2000, is reserved, maintenance or unallocated support is $ as of. (date) and/or medical support is as of. (date). Oo c) The amount of child support cannot be expressed exclusively as a dollar amount because all or a portion of the Obligor's net income is uncertain as to one time of payment, or amount. Bt d)_Retroactive child support is $ I 8 from 3 - a AG to q 1D VG The [Obligee [_] Obligee's Attorney LY Obligor LJ Obligor's Attorney_[y- Assistant State's Attorney, being present (2 This matter being an Interstate Case, [_] Voluntary Acknowledgement of Paternity was signed on It is Ordered: S}-After hearing (_] By agreement of the pee Ahan sha that: Sh4G LEAL , Obligor, is to provide: oO MAINTENANCE (Do not complete this section if Unallocated Support is ordered.) Payment Amount: Payment Frequency: Current Maintenance: $ Li every week Devery other week Arrearage Payment $ CU monthly LD twice each month on & Payments Begin: (date) Di other (date) AXCHILD SUPPORT OR [] UNALLOCATED SUPPORT Payment Amount: Payment Frequency: Current Child Support Payment or Unallocated Support Payment: IAS +O Clevery week LD every other week yf monthly Arrearage/Retroactive Payment: $ 10-0 C1 twice each month on & Other Payment: $ UD other (date) Payments Begin: g- 13, _/ F (date) Judgment in the amount of $ /[6SOQ-O1D _ plus interest of $ ~~ for a total due ofs/L§O *@y is entered against the Obligor on the arrears. SAO 2500-1 [Rev. 08/17] Page iF. ofS so aaemtLD PERCENTAGE AMOUNT OF CHILD SUPPORT (Complete this section only if finding (c) is checked above.) Oo In addition to the specific dollar amount of support ordered above, current child support shall be paid in the amount of % of Obligor's payable ! The Obligor is further ordered to provide income records sufficient to determine and enforce the percentage amount of child support within 7 days of receipt of income subject to this percentage assessment, to the [_]Obligee and [_] Clerk of the Court. {J ADDITIONAL CONDITIONS OR FINDINGS o Child support payment amount deviates from the amount required by statutory minimum guidelines. The amount of support that would have been required under the guidelines is $ . Reasons for deviation: oO Child Support is based on the needs of the child. The Child/ren covered by this Order is/are: nse!) Washinton re Montirvear ot Binns PALO A Month/Year of Birth: Month/Year of Birth: Month/Year of Birth: PAYMENT ARRANGEMENTS he (Payments must be sent to the STATE DISBURSEMENT UNIT if this box is checked.) A Notice to Withhold Income shall be issued immediately and shall be served on the employer at the address listed in this Order. Payments shall be made payable to the State Disbursement Unit and sent to the State Disbursement Unit at P.O. Box 5400, Carol Stream, IL 60197-5400. Payments must include CASE NUMBER, COUNTY of the Court issuing this Order, and Obligor's name and social security number. Any subsequent employer may be served with a Notice to Withhold Income without further order of the Court. In addition to and separate from amounts ordered to be paid as maintenance or child support, the Obligor shall pay a $36 per year Separate Maintenance and Child Support Collection Fee. This sum shall be paid directly to the Office of the Clerk of the Circuit Court, Child Support Division, Richard J. Daley Center, 50 West Washington Street, Room LLO1, Chicago, IL 60602, and not to the State Disbursement Unit. DELINQUENCY If the Obligor becomes delinquent in the payment of support oer the entry of this Order for Support, the Obligor must pay, in addition to the current support obligation, the sum of (a) $ 5S 1 OW for delinquent child support per the payment _ frequency ordered above for child support, and (b) $ for delinquent maintenance or unallocated support per the payment frequency ordered above for maintenance or unallocated support, until the delinquency is paid in full. (This additional amount, the total of (a) and (b), shall not be less than 20 percent of the total of the current support amount and the amount to be paid for payment of any arrearage stated in the Order for Support.) A support obligation, or any portion of a support obligation which becomes due and remains unpaid for 30 days or more, shall accrue interest at the rate of 9% per annum. pocketNo: GALS OD) EF IV-D No: C 03/94 C3 SAO 2500-1 [Rev. 08/17] Page 2 of 5TERMINATION : | This obligation to pay child support terminates mite child [[] youngest child's 18" birthdate unless modified by written order of the Court or unless the child is still attending high school after attaining the age of 18, then the termination date shall be the earlier of the child's high school graduation or the date on which the child will attain the age of 19. This termination date does not apply to any arrearage that may remain unpaid on that date. ARREARS PAYMENT If on the termination date (if no termination date, then on date the child attains majority or otherwise emancipates) there is an unpaid arrearage or delinquency equal to at least one month's support obligation, the amount being paid immediately preceding termination, including any current support payment, arrearage payment and/or any delinquency, will continue to be collected as an obligation, not as current support, but as a periodic payment toward satisfaction of the unpaid support. MEDICAL INSURANCE The [_]Obligor, [[] Obligee, [| Obligor and Obligee, shall provide health insurance for the child(ren): [_] as provided in previous order entered on ; []by enrolling them in any health insurance coverage available through the [J Obligor's, [] Obligee's, [=] Obligor's and Obligee's, employment or [_] by securing a private health insurance policy, accepted by the Obligor and Obligee or approved by the Court, which names the child(ren) as beneficiary. The Obligor shall provide to the Obligee a copy of the insurance policy and the insurance card within 45 days. The employer or labor union or trade union shall disclose information concerning dependent coverage plans whether or not a court order for medical support has been entered. 750 ILCS 5/505.2. Oo The Obligor is liable for % of medical expenses incurred by the minor child(ren) and not covered by insurance. Oo Upon obtaining employment which provides dependent health/hospitalization insurance at reasonable costs; or upon Obligor's employer making dependent health/hospitalization insurance available at reasonable costs, Obligor must immediately enroll the aforementioned child(ren) in the employer's health/lospitalization insurance plan. Re The issue of medical insurance s reserved 7 yigharaWi Stok Prou idan - lag Pahilerbre It is further ordered that (except when the Court finds that the physical, mental or emotional health of a party or that of a minor child, or both, would be seriously endangered by disclosure of the party's address): The Obligor shall give written notice to the Clerk of the Court, and ifa party is receiving child and spouse services under Article X of the Illinois Public Aid Code, to the Illinois Department of Healthcare and Family Services, (HFS) within 7 days, of: . any new residential, mailing address or telephone number; . the name, address and phone number of any new employer, and; . the policy name and identifying number(s) of health insurance coverage available. The Obligor shall submit a written report of termination of employment and of new employment, including name and address of the new employer, to the Clerk of the Court and the Obligee within 10 days. Obligor and Obligee shall advise each other of a change of residence within 5 days except when the Court finds that the physical, mental or emotional health of a party or that of a minor child, or both, would be seriously endangered by disclosure of the party's address. An Obligee receiving payments through income withholding shall notify the Clerk of the Court and the State Disbursement Unit within 7 days, of a change in residence. The Obligor and Obligee shall report to the Clerk of the Court any change of information included in the Child Support Data Sheet (Exhibit 1) within 5 business days of such a change. UNEMPLOYMENT { Obligor is unemployed and is ordered to'seek employment. The Obligor must report periodically to the Court with a diary listing the name, address, telephone number and contact person of each employer with which he or she has sought employment. Obligor is ordered to report to the Department of Employment Security for job search services or to complete an application with the local Job Training Partnership Act provider for participation in job search, training or work programs. [i Obligor is unemployed and is ordered to put forth a diligent effort to obtain employment and to cooperate with all instructions of HFS. Upon finding employment, the Obligor shall notify HFS in writing at 36 South Wabash, #* Floor, Chicago, IL 60603 within 7 days. The Obligor's failure to comply with the requirements of this Order may result in the State's Attorney seeking a contempt of court order. Docket No.: /Gdb50] eq wpnic O31 FIG LFF SAO 2500-1 [Rev. 08/17] Page 3 of 5(GENETIC TEST REIMBURSEMENT: Obliigor shall pay $ to HFS for a genetic, itest reimbursement. Payments must be made in lump sum or installments by personal check or money order payable to HFS and either mailed to: HFS, Title IV-D Accounting Unit, P.O. Box 19138, Springfield, IL 62705-9138, or conveyed as otherwise directed by the Court. Payment must include IV-D number as shown on this Order. This Order does not preclude HFS from collecting any arrearage established by or which may accrue under this Order for Support by use of the offset provisions of Section 6402 (c) of the Internal Revenue Code of 1954, and 15 ILCS 405/10.05(a) as amended, Such arrearage shall be considered as “past due” or “due and payable” within the meaning of said statutory provisions. This order does not preclude the placing of a lien on real and personal assets or initiating a proceeding for garnishment, attachment of sequestration pursuant to law and the Code of Civil Procedure. This order of support supersedes any and all prior orders of support under this case number. COTHER: 4 ( This cause is continued for 6 ff Ca l/ to at Room at oO Richard J. Daley Center, 50 W. Washington, oO Richard J. Daley Center, 50 W. Washington, Chicago, IL Concourse Level - Room CL24, Chicago, IL Oo District 2 - 5600 Old Orchard Road, Skokie, IL oO District 5 - 10220 South 76" Ave., Bridgeview, IL Oo District 3 - 2121 Euclid Ave., Rolling Meadows, IL [] District 6 - 16501 South Kedzie, Markham, IL oO District 4 - 1500 Maybrook Drive, Maywood, IL (1) without further notice [_] without further notice to Petitioner [_] without further notice to Respondent FAILURE TO APPEAR MAY RESULT IN ENTRY OF A DEFAULT JUDGMENT Docket No.: LGA LSOlPY . IV-DNo:C (3 197k $3 SAO 2500-1 [Rev. 08/17] Page 4of5(J FOR EXPEDITED CHILD SUPPORT CASES ONLY: ‘ ' I NOTICE OF RIGHT TO REQUEST A JUDICIAL HEARING: You have a right to request a Judicial Hearing. If either party does not agree to the recommended Order or any part thereof, this case will be transferred for an immediate Judicial Hearing. This Order may be vacated or amended within 30 days of its entry. This Order is not valid until signed by a judge. So recommended to the Court by the Hearing Officer this day of ’ . Hearing Officer's Signature Petitioner/ Obligee's Signature Respondent/ Obligor's Signature y Petitioner/ Obligee's Attorney's Signature Respondent/ Obligor's Attorney's Signature FAILURE TO OBEY ANY OF THE PROVISIONS OF THIS ORDER MAY RESULT IN A FINDING OF CONTEMPT OF COURT tlie ha Date KIMBERLY M. FOXX # 17052 State's Atto of Cook County By: 28 North Clark, Suite 30 Chicago, Illinois 60602 (G12) 345-2200 sao.csed@cookcountyil.gov ‘Asdistant State's Attorney, fone HFS) Docket No.: JFE&LSOLPG IV-D No: C. 03/79 4L73 : SAO 2500-1 [Rev. 08/17] Page Sof 5IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS ' DOMESTIC RELATIONS DIVISION Hingis Department of Healthggre and Family Services ex rel., . “Tomnmelia Mekan . poset no: LFA LSOIEF Petitioner, | Iv-DNo:c OD! 13, Calendar No.: PL ORDER OF P. ITAGE This matter coming to be heard on a complaint to establish the parentage of, Shantel l Washingin SI _ born on 9 Jedoe . PRESENT ARE: (X— Petitioner on behalf of a minor child/ren Respondent “BYP Assistant State's Attorney’ [[] Public Defender oO Petitioner's Attorney [_] Respondent's Attorney [7] Court Interpreter [_] Child/ren -~vs- Fhantel! Washingbn Respondent. Hearing is: [By Agreement [[] Default [[] Bench Trial THE COURT FINDS AS FOLLOWS: & Respondent, was [_] personally served xf served by substitution on 4 4 ‘S" ! 1 : Respondent is not in the military [_] is in the military. Respondent has appeared and waived any defects in process. x Respondent admits parentage. Be Respondent received a copy ope genetic test,results and was advised of his rights to trial. The natural mother is Tommelia Makau date of birth a) and has testified Min person [_] pursuant to affidavit that Respondent is the natural father of taal child/ren id that no other person could be the father. Therefore, the Court further finds that the natural father is It noah ‘ f o~ The Respondent: Name: andel 1 Washington pate of Birth 1/1 FFI. on Curent Address: PAL Hunees Te Fra | City, Sate, zip Sun Prairie, 0) S3S% IT IS HEREBY ORDE! 1. That Shank wd aching ton is adjudicated the natural and biological father of said minor child/ren. 2. Retroactive support is: Lireserved [_] continued for nearing (1 denied—-S¥} granted by separate Order [“] withdrawn. 3. Support is: [Jreserved [_] continued for hearing-fP] granted by separate Order (F withdrawn. 4. Medical provisions [_] reserved continued for hearing []denied [] granted by separate Order Fe} withdrawn. 5. The child/ren's legal name shall be 6. Custody and Visitation [[] Mother Father shall have custody of minor child/ren. (_] Father Mother shall have reasonable visitation rights. Reserve []Custody, [[]Visitation —)— 7. Continuance Date of C. l/ o This matter is continued for Hearing on as 20 at at Oo Richard J. Daley Center, 50 W. Washington, Room Chicago, IL for the purpose of oO Richard J. Daley Center, 50 W. Washington, Concourse Level - Rm. CL24, Chicago, IL for the purpose of oO District 2 - 5600 Old Orchard Road, Room Skokie, IL for the purpose of Oo District 3 - 2121 Euclid Avenue, Room » Roliing Meadows, IL for the purpose of Oo District 4 - 1500 Maybrook Drive, Room *, Maywood, IL for the purpose of [1 __ District 5 - 10200 South 76" Avenue, Room , Bridgeview, IL for the purpose of oO District 6 - 16501 South Kedzie, Room Markham, IL for the purpose of (without further notice [[] with notice to [[] Petitioner [_] Respondent [_] with affidavit of mailing ‘SAO 2500-003 I-PAD [Rev. 05/17] Page 1 of 28. « (senehc Jest Reotts gow 94 7994p Ordeal; F eaten, I RESPONDENT'S FAILURE TO APPEAR MAY RESULT IN ENTRY OF A DEFAULT JUDGMENT AGAINST RESPONDENT. NOTICE OF RIGHT TO REQUEST A JUDICIAL HEARING: You have a right to request a Judicial Hearing. If either party does not agree to the recommended Order or any part thereof, this case will be transferred for an immediate Judicial Hearing. THIS ORDER IS NOT VALID UNTIL SIGNED BY A JUDGE So recommended to this Court by the Hearing Officer this Hearing Officer's Signature lef loofre Sigring Petitioner's Signature Petitioner's Attorney KIMBERLY M. FOXX # 17052 State's Attokut¥ of Cook Count By: orth Clark, Suite 300 Chicago, Illinois 60602 (312) 345-2200 sao.csed@cookcountyil.gov_ Assjétant State's Attorney, (Attorney “y 28 Docket No.: ‘SAO 2500-003 I-PAD [Rev. 05/17] dent's Signature Respondent's Attorney ENTERED: q / iol (Tt weal HEN a Judge's No. IV-D No.: C Page2of2